Irritable bowel syndrome (IBS) is a common functional bowel disorder characterized by abdominal pain and change in defecation pattern. This review addresses the topic of possible sex (genetic, biological) and gender (experiential, perceptual) differences in individuals with and without IBS. Several observations make the topic important. First, there is a predominance of women as compared to men who seek health care services for IBS in the United States and other industrialized societies. Second, menstrual cycle-linked differences are observed in IBS symptom reports. Third, women with IBS tend to report greater problems with constipation and nongastrointestinal complaints associated with IBS. Fourth, serotonin (5-HT3) receptor antagonist and 5-HT4 partial agonist drugs appear to more effectively diminish reports of bowel pattern disruption in women with IBS as compared to men. This review examines sex and gender modulation of gastrointestinal motility and transit, visceral pain sensitivity, autonomic nervous system function, serotonin biochemistry, and differences in health care-seeking behavior for IBS.
Get full access to this article
View all access options for this article.
References
1.
Aggarwal A, Cutts TF, Abell TL, Cardoso S, Familoni B, Bremer J, Karas J. 1994. Predominant symptoms in irritable bowel syndrome correlate with specific autonomic nervous system abnormalities. Gastroenterology106(4):945-950.
2.
Berkley KJ. 1997. Sex differences in pain. Behav Brain Sci20:371-380.
3.
Berman SM, Chang L, Suyenobu B, Derbyshire SW, Stains J, Fitzgerald L, Mandelkern M, Hamm L, Vogt B, Naliboff BD, and others. 2002. Condition-specific deactivation of brain regions by 5-HT3 receptor antagonist Alosetron. Gastroenterology123(4):969-977.
4.
Berman S, Munakata J, Naliboff BD, Chang L, Mandelkern M, Silverman D, Kovalik E, Mayer EA. 2000. Gender differences in regional brain response to visceral pressure in IBS patients. Eur J Pain4(2):157-172.
5.
Blanchard EB, Scharff L. Payne A, Schwarz SP, Suls JM, Malamood H. 1992. Prediction of outcome from cognitive-behavioral treatment of irritable bowel syndrome. Behav Res Ther30(6):647-650.
6.
Bond E, Heitkemper M, Perigo R. 1996. Gastric emptying and gastric-intestinal transit in rats with varying ovarian hormone status. Nurs Res45:218-224.
7.
Bouin M, Plourde V, Boivin M, Riberdy M, Lupien F, Laganiere M, Verrier P, Poitras P. 2002. Rectal distention testing in patients with irritable bowel syndrome: sensitivity, specificity, and predictive values of pain sensory thresholds. Gastroenterology122(7):1771-1777.
8.
Bradesi S, Eutamene H, Fioramonti J, Bueno L. 2002. Acute restraint stress activates functional NK1 receptor in the colon of female rats: involvement of steroids. Gut50(3):349-354.
9.
Bruce LA, Behsudi FM. 1979. Progesterone effects on three regional gastrointestinal tissues. Life Sci27;25(9):729-734.
10.
Burr RL, Heitkemper M. Jarrett M, Cain KC. 2000. Comparison of autonomic nervous system indices based on abdominal pain reports in women with irritable bowel syndrome. Biol Res Nurs2(2):97-106.
11.
Camilleri M, Atanasova E, Carlson P, Ahmad U, Kim H, Viramontes E, McKinzie S, Urrutia R. 2002. Sertonin-transporter polymorphism pharmacogenetics in diarrhea-predominant irritable bowel syndrome. Gastroenterology123:425-432.
12.
Chen TS, Doong ML, Chang FY, Lee SD, Wang PS. 1995. Effects of sex steroid hormones on gastric emptying and gastrointestinal transit in rats. Am J Physiol268:G171-G176.
13.
Chiloiro M, Darconza G, Piccioli E, De Carne M, Clemente C, Riezzo G. 2001. Gastric emptying and orocecal transit time in pregnancy. J Gastroenterol36(8):538-543.
14.
Cowan MJ, Pike K, Burr RL. 1994. Effects of gender and age on heart rate variability in healthy individuals and in persons after sudden cardiac arrest. J Electrocardiology27(Suppl):P1-P9.
15.
Cremonini F, Mullan BP, Camilleri M, Burton DD, Rank MR. 2002. Performance characteristics of scintigraphic transit measurements for studies of experimental therapies. Aliment Pharmacol Ther16(10):1781-1790.
16.
Crowell MD, Dubin NH, Robinson JC, Cheskin LJ, Schuster MM, Heller BR, Whitehead WE. 1994. Functional bowel disorders in women with dysmenorrhea. Am J Gastroenterol89:1973-1977.
17.
Davison JS, Davison MC, Hay DM. 1970. Gastric emptying in late pregnancy and labour. J Obstet Gynaecol Br Commonwealth77:37-41.
18.
Degen LP, Phillips SF. 1996. Variability of gastrointestinal transit in healthy women and men. Gut39(2):299-305.
19.
Drossman DA, Whitehead WE, Camilleri M. 1997. Irritable bowel syndrome: a technical review for practice guideline development. Gastroenterology112:2120-2137.
20.
Elsenbruch S, Orr WC. 2001. Diarrhea- and constipation-predominant IBS patients differ in postprandial autonomic and cortisol responses. Am J Gastroenterol96:460-466.
21.
Giamberardino MA, Affaitati G, Valente R, Iezzi S, Vecchiet L. 1997. Changes in visceral pain reactivity as a function of estrous cycle in female rats with artificial ureteral calculosis. Brain Res774:234-238.
22.
Giamberardino MA, Berkley KJ, Iezzi S, de Bigontina P, Vecchiet L. 1997. Pain threshold variations in somatic wall tissues as a function of menstrual cycle, segmental site and tissue depth in non-dysmenorrheic women, dysmenorrheic women and men. Pain71:187-197.
23.
Gill RC, Bowes KL, Kingma YJ. 1985. Effect of progesterone on canine colonic smooth muscle. Gastroenterology88:1941-1947.
24.
Gwee KA, Leong YL, Graham C, McKendrick MW, Collins SM, Walters SJ, Underwood JE, Read NW. 1999. The role of psychological and biological factors in postinfective gut dysfunction. Gut44:400-406.
25.
Heitkemper M, Cain K, Jarrett M, Burr R, Hertig V. 2003. Symptoms across the menstrual cycle in women with irritable bowel syndrome. Am J Gastroenterol. In press.
26.
Heitkemper M, Jarrett M, Cain K, Burr R, Levy RL, Feld A, Hertig V. 2001. Autonomic nervous system function in women with IBS. Dig Dis Sci46:1276-1284.
27.
Heitkemper MM, Jarrett M. 1992. Pattern of gastrointestinal and somatic symptoms across the menstrual cycle. Gastroenterology102(2):505-513.
28.
Heitkemper MM, Jarrett M, Cain K, Shaver J, Walker E, Lewis L. 1995. Daily gastrointestinal symptoms in women with and without a diagnoses of IBS. Dig Dis Sci40:1511-1517.
29.
Heitkemper MM, Jarrett M, Taylor P, Walker E, Landenburger K, Bond EF. 2001. Sexual and physical abuse in women with irritable bowel syndrome. Nurs Res50:15-23.
30.
Heitkemper MM, Shaver JF, Mitchell E. 1988. Gastrointestinal symptoms and bowel patterns across the menstrual cycle in dysmenorrheic and non-dysmenorrheic women. Nurs Res37:108-113.
31.
Hinds JP, Stoney B, Wald A. 1989. Does gender or the menstrual cycle affect colonic transit? Am J Gastroenterol84(2):123-126.
32.
Houghton LA, Lea R, Jackson N, Whorwell PJ. 2002. The menstrual cycle affects rectal sensitivity in patients with irritable bowel syndrome but not healthy volunteers. Gut50:471-474.
33.
Hutson WR, Roehrkasse RL, Wald A. 1989. Influence of gender and menopause on gastric emptying and motility. Gastroenterology96:11-17.
34.
Jain AP, Gupta OP, Jajoo UN, Sidhwa HK. 1991. Clinical profile of irritable bowel syndrome at a rural based teaching hospital in central India. J Assoc Physicians India39(5):385-386.
35.
Jarrett M, Burr RL, Cain KC, Hertig V, Weisman P, Heitkemper MM. 2003. Anxiety and depression are related to autonomic nervous system function in women with irritable bowel syndrome. Dig Dis Sci48:386-394.
36.
Jarrett M, Heitkemper MM, Cain K, Tuftin M, Walker E, Bond E, Levy R. 1998. The relationship between psychological distress and gastrointestinal symptoms in women. Nurs Res47:154-161.
37.
Kamm MA, Farthing MJ, Lennard-Jones JE. 1989. Bowel function and transit rate during the menstrual cycle. Gut30:605-608.
38.
Lampe JW, Fredstrom SB, Slavin JL, Potter JD. 1993. Sex differences in colonic function: a randomised trial. Gut34(4):531-536.
39.
Lee OY, Mayer EA, Schmulson M, Chang L, Naliboff B. 2001. Gender-related differences in IBS symptoms. Am J Gastroenterol96(7):2184-2193.
40.
Mangel AW, Northcutt AR. 1999. Review article: the safety and efficacy of alosetron, a 5-HT3 receptor antagonist, in female IBS patients. Aliment Pharmacol Ther13(Suppl 2):77-82.
41.
Mayer EA, Collins SM. 2002. Evolving pathophysiologic models of functional gastrointestinal disorders. Gastroenterology122:2032-2048.
42.
Mearadji B, Penning C, Vu MK, van der Schaar PJ, van Petersen AS, Kamerling IM, Masclee AA. 2001. Influence of gender on proximal gastric motor and sensory function. Am J Gastroenterol96(7):2066-2073.
43.
Meier R, Beglinger C, Dederding JP, Meyer-Wyss B, Fumagalli M, Rowedder A, Turberg Y, Brignoli R. 1995. Influence of age, gender, hormonal status and smoking habits on colonic transit time. Neurogastroenterol Motil7(4):235-238.
Muller-Lissner SA, Fumagalli I, Bardhan KD. 2001. Tegaserod, a 5-HT(4) receptor partial agonist, relieves symptoms in irritable bowel syndrome patients with abdominal pain, bloating and constipation. Aliment Pharmacol Ther15:1655-1666.
46.
Naliboff BD, Derbyshire SW, Munakata J, Berman S, Mandelkern M, Chang L, Mayer EA. 2001. Cerebral activation in patients with irritable bowel syndrome and control subjects during rectosigmoid stimulation. Psychosom Med63(3):365-375.
47.
Novick J, Miner P, Krause R, Glebass K, Bliesath H, Ligozios G, Ruegg P, Lefkowitz M. 2002. A randomized, double-blind, placebo-controlled trial of tegaserod in female patients suffering from irritable bowel syndrome with constipation. Aliment Pharmacol Ther16:1877-1888.
48.
Rao SS, Sadeghi P, Beaty J, Kavlock R, Ackerson K. 2001. Ambulatory 24-h colonic manometry in healthy humans. Am J Physiol Gastrointest Liver Physiol280(4):G629-G639.
49.
Ringel Y, Sperber AD, Drossman DA. 2001. Irritable bowel syndrome. Annu Rev Med52:319-338.
50.
Roy BN, Reid RL, Van Vugt DA. 1999. The effects of estrogen and progesterone on corticotropin-releasing hormone and arginine vasopressin messenger ribonucleic acid levels in the paraventricular nucleus and supraoptic nucleus of the rhesus monkey. Endocrinology140(5):2191-2198.
51.
Soffer EE, Kongara K, Achkar JP, Gannon J. 2000. Colonic motor function in humans is not affected by gender. Dig Dis Sci45(7):1281-1284.
52.
Stanghellini V, Tosetti C, Barbara G, De Giorgio R, Cogliandro L, Cogliandro R, Corinaldesi R. 2002. Dyspeptic symptoms and gastric emptying in the irritable bowel syndrome. Am J Gastroenterol97(11):2738-2743.
53.
Taylor SE, Klein LC, Lewis BP, Gruenewald TL, Gurung RA, Updegraff JA. 2000. Biobehavioral responses to stress in females: tend-and-befriend, not fight-or-flight. Psychol Rev107:411-429.
54.
Teff KL, Alavi A, Chen J, Pourdehnad M, Townsend RR. 1999. Muscarinic blockade inhibits gastric emptying of mixed-nutrient meal: effects of weight and gender. Am J Physiol276:R707-R714.
55.
Toner BB, Akman D. 2000. Gender role and irritable bowel syndrome: literature review and hypothesis. Am J Gastroenterol95:11-16.
56.
Toner BB, Garfinkel PE, Jeejeebhoy KN. 1990. Psychological factors in irritable bowel syndrome. Can J Psychiatry35:158-161.
57.
Verne GN, Price DD. 2002. Irritable bowel syndrome as a common precipitant of central sensitization. Curr Rheumatol Rep4(4):322-328.
58.
Viramontes BE, Camilleri M, McKinzie S, Pardi DS, Burton D, Thomforde GM. 2001. Gender-related differences in slowing colonic transit by a 5-HT3 antagonist in subjects with diarrheapredominant irritable bowel syndrome. Am J Gastroenterol96:2671-2676.
59.
Wald A, Van Thiel DH, Hoechstetter L, Gavaler JS, Egler KM, Verm R, Scott L, Lester R. 1981. Gastrointestinal transit: the effect of the menstrual cycle. Gastroenterology80:1497-1500.
60.
Wald A, Van Thiel DH, Hoechstetter L, Gavaler JS, Egler KM, Verm R, Scott L, Lester R. 1982. Effect of pregnancy on gastrointestinal transit. Dig Dis Sci27:1015-1018.
61.
Walker EA, Roy-Byrne PP, Katon WJ, Li L, Amos D, Jiranek G. 1990. Psychiatric illness and irritable bowel syndrome: a comparison with inflammatory bowel disease. Am J Psychiatry147(12):1656-1661.
62.
Walsh JW, Hasler WL, Nugent CE, Owyang C. 1996. Progesterone and estrogen are potential mediators of gastric slow-wave dysrhythmias in nausea of pregnancy. Am J Physiol33:G506-G514.
63.
Weissman MM, Bland RC, Canino GF, Faravelli C, Greenwald S, Hwu HG, Joyce PR, Karam EG, Lee CK, Lellouch J, and others. 1996. Cross-national epidemiology of major depression and bipolar disorder. JAMA276:293-299.
64.
Wizemann TM, Pardue ML, Eds. Institute of Medicine Committee on Understanding the Biology of Sex and Gender. 2001. Exploring the biological contributions to human health: does sex matter? Washington, DC: National Academy Press.
65.
Yildirir A, Kabakci G, Akgul E, Tokgozoglu L, Oto A. 2002. Effects of menstrual cycle on cardiac autonomic innervation as assessed by heart rate variability. Ann Noninvasive Electrocardiol7:60-63.
